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1.
Pan Afr Med J ; 33: 216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692727

RESUMO

The association of myoma and pregnancy is becoming more frequent due to the increasing age of first pregnancy. It may affect the outcome of fertility, pregnancy, labor and peripartum course. A 37 years old patient was referred to our unit for discovering uterine leiomyoma at 37 weeks of pregnancy. Ultrasound screening showed a praevia isthmic leiomyoma measuring 16cm. A caesarean delivery was scheduled and a large interstitial isthmic uterine myoma measuring 25cm was found. Hysterectomy was corporeal. The post-operative and puerperium course was normal.


Assuntos
Leiomioma/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Neoplasias Uterinas/diagnóstico por imagem , Adulto , Cesárea , Feminino , Humanos , Histerectomia/métodos , Leiomioma/cirurgia , Gravidez , Neoplasias Uterinas/cirurgia
2.
Pan Afr Med J ; 33: 279, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692819

RESUMO

Multicystic dysplastic kidney (MCDK) is the most common Congenital Abnormalities of Kidney and Urinary Tract (CAKUT) in clinical practice. Its etiology and pathogenesis are still controversial and obstruction is a generally accepted causative assumption. Obstetric ultrasound is the gold standard for prenatal diagnosis and for the detection of other associated malformations. Prenatal management is based on ultrasound monitoring of pregnancy, of the disease, of the occurrence of other anomalies and of the amount of amniotic fluid. This study aims to report our experience in the Department of Gynecology-Obstetrics 2 at the University Hospital Hassan II-Fez in order to clarify the epidemiology of MCDK, highlight the role of obstetric ultrasound in positive and etiological diagnosis while describing the various sonographic appearances. It is essential to schedule for screening tests during pregnancy in order to assess the evolution of the disease diagnosed in the prenatal period, to implement a strategy in postpartum care and to establish a prognosis.


Assuntos
Líquido Amniótico/metabolismo , Rim Displásico Multicístico/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Anormalidades Múltiplas/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos
3.
BMJ ; 367: l5517, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615781

RESUMO

OBJECTIVES: To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions. DESIGN: Pragmatic, multicentre, stepped wedge cluster randomised trial. SETTING: 60 midwifery practices in the Netherlands. PARTICIPANTS: 13 046 women aged 16 years or older with a low risk singleton pregnancy. INTERVENTIONS: 60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks' gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies. MAIN OUTCOME MEASURES: The primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score <4, impaired consciousness, asphyxia, seizures, assisted ventilation, septicaemia, meningitis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leucomalacia, or necrotising enterocolitis. Secondary outcomes were two composite measures of severe maternal morbidity, and spontaneous labour and birth. RESULTS: Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks' gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), P<0.001). The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. After adjustment for confounders, the difference between the groups was not significant (odds ratio 0.88, 95% confidence interval 0.70 to 1.20). The intervention strategy showed a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). Maternal outcomes and other obstetric interventions did not differ between the strategies. CONCLUSION: In low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies. TRIAL REGISTRATION: Netherlands Trial Register NTR4367.


Assuntos
Doenças do Recém-Nascido , Ultrassonografia Pré-Natal , Adolescente , Índice de Apgar , Análise por Conglomerados , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Humanos , Incidência , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Tocologia/métodos , Tocologia/estatística & dados numéricos , Países Baixos/epidemiologia , Mortalidade Perinatal , Gravidez , Resultado da Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Gravidez na Adolescência , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/estatística & dados numéricos
4.
Isr Med Assoc J ; 21(10): 653-657, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599505

RESUMO

BACKGROUND: Complete hydatidiform mole and a co-existing normal fetus (CHMCF) is associated with a high complication rate. A possible association with assisted conception might increase the prevalence of CHMCF. OBJECTIVES: To study the potential association between assisted conception and the risks of CHMCF. METHODS: Case series at a single university hospital from 2008 to 2018 are presented and contrasted with data from a comprehensive literature review (1998-2018). Cases were identified from the institutional database that matched the sonographic criteria for CHMCF. A literature review showed comparable cases. RESULTS: None of the three pregnancies presented in this article resulted in a viable fetus, all were aborted. One of the three patients needed chemotherapy due to gestational trophoblastic neoplasia (GTN). A literature search identified 248 reported cases in which 22 fetuses (9%) reached term, 88/248 (35%) progressed to GTN, and 25/120 (21%) were conceived following assisted conception. From 2008 until 2018 at our medical facility, there were 3144 twin pregnancies of which 1667 (53%) were conceived using assisted conception. In our cohort, there was no statistical trend for assisted conception as an etiological factor for CHMCF. CONCLUSIONS: No association between assisted conception and the risk for CHMCF was established at our hospital, although approximately one-quarter of all reported CHMCF pregnancies are attributed to assisted conception technology. However, these data are not always reported, making it difficult to draw definitive conclusions.


Assuntos
Mola Hidatiforme/patologia , Gravidez de Gêmeos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Neoplasias Uterinas/patologia , Aborto Eugênico , Aborto Induzido , Adulto , Feminino , Humanos , Mola Hidatiforme/terapia , Doença Iatrogênica , Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Ultrassonografia Pré-Natal/métodos , Neoplasias Uterinas/terapia
5.
Medicine (Baltimore) ; 98(42): e17492, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626103

RESUMO

Fetal pulmonary atresia with intact ventricular septum (PA/IVS) is a rare congenital heart disease. The present study aimed to classify PA/IVS and determine the relationship between prenatal echocardiographic characteristics and postnatal biventricular or univentricular repair strategies.A total of 51 fetuses with PA/IVS were examined from 2012 to 2019. Data on prenatal echocardiography, associated anomaly, karyotype, and outcome were collected. Two-dimensional measurements included tricuspid valve (TV) z-score, mitral valve (MV) z-score, TV/MV ratio, and ratio of right to left ventricle (RV/LV) length, whereas color Doppler measurements included degree of tricuspid regurgitation (TR), ventriculo-coronary artery communication (VCAC), tricuspid inflow duration (TID), cardiac cycle duration (CCD), middle cerebral artery pulsatility index (MCA PI), and umbilical artery pulsatility index (UA PI). Diagnostic classification was based on the development of RV and the presence or absence of VCAC. Postnatal evaluation was divided according biventricular or univentricular repair.Of the 51 fetuses with PA/IVS, 20 were type I, 17 were type II, and 14 were type III. Only one fetus exhibited right aortic arch. The karyotype of all the fetuses was normal. Of the 28 patients who underwent postnatal surgery, 13 (46%) underwent biventricular repair and 15 (54%) underwent univentricular repair. TV z-score was significantly higher for the biventricular repair group compared with univentricular repair group (-1.20 ±â€Š0.98 vs -4.33 ±â€Š0.80, P = .000). TV/MV, RV/LV length, and TID/CCD were significantly higher for the biventricular repair group than the univentricular repair group (0.81 ±â€Š0.14 vs 0.54 ±â€Š0.09, 0.71 ±â€Š0.11 vs 0.49 ±â€Š0.09, 39.20 ±â€Š3.84 vs 29.16 ±â€Š4.58, P = .000). Moderate or severe TR and VCAC were significantly different between the 2 groups (P = .000). Gestational age, MCA PI, and UA PI did not differ between the 2 groups (P = .72, P = .36, P = .06). The cutoff values for the biventricular repair characteristic curves were TV z-score >-3.28, TV/MV ratio >0.71, RV/LV length >0.62, and TID/CCD >33.95%. The sensitivities of the TV z-score, TV/MV, RV/LV length, and TID/CCD were 100%, 77%, 85%, and 92%, respectively. The specificities of the TV z-score, TV/MV, RV/LV length, and TID/CCD were 94%, 100%, 100%, and 94%, respectively.Fetal echocardiography was able to classify PA/IVS according to variable degree of RV and VCAC. In fetal PA/IVS, TV z-score >-3.28, TV/MV >0.71, RV/LV length >0.62, TID/CCD >33.95%, moderate and severe TR, and the absence of VCAC were associated with postnatal biventricular repair strategy. These findings may have implications for prenatal counseling and prediction of fetal outcome.


Assuntos
Ecocardiografia/estatística & dados numéricos , Coração Fetal/diagnóstico por imagem , Cardiopatias Congênitas/classificação , Cardiopatias Congênitas/diagnóstico por imagem , Atresia Pulmonar/classificação , Atresia Pulmonar/diagnóstico por imagem , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto , Ecocardiografia/métodos , Feminino , Idade Gestacional , Cardiopatias Congênitas/embriologia , Humanos , Valor Preditivo dos Testes , Gravidez , Prognóstico , Atresia Pulmonar/embriologia , Valores de Referência , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/métodos , Adulto Jovem
6.
Pan Afr Med J ; 33: 86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489064

RESUMO

Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year from 01/01/2015 to 01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta accreta spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. Leaving the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta accreta spectrum disorders is an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.


Assuntos
Histerectomia/métodos , Placenta Acreta/diagnóstico , Ultrassonografia Pré-Natal/métodos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Marrocos , Placenta Acreta/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Fatores de Risco
7.
Medicine (Baltimore) ; 98(29): e16458, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335703

RESUMO

We evaluated the clinical value of the cerebroplacental ratio (CPR) in predicting neonatal acidosis according to the gestational weeks in late pregnancy.From July 2016 to June 2017, 1018 neonates without acidosis and 218 neonates with acidosis (confirmed postpartum) underwent a prenatal examination and hospital delivery at 28 to 41 weeks in our hospital. The CPR was calculated as the ratio of the prenatal middle cerebral artery-pulsation index (MCA-PI) to the umbilical artery-pulsation index (UA-PI).In neonates without acidosis, the fetal UA-PI decreased with increased gestational age during late pregnancy. Similarly, the MCA-PI decreased with increased gestational age, and decreased significantly during the full pregnancy term. Additionally, the CPR peaked in the middle of the late pregnancy period and then decreased. In contrast, in neonates with acidosis, the prenatal UA-PI increased significantly, MCA-PI declined significantly, and CPR declined significantly in relation to normal values (P < .05). For the prediction of neonatal acidosis, the UA-PI was suitable after 32 weeks and the MCA-PI was suitable before 37 weeks. The cutoff values of the CPR for the prediction of neonatal acidosis at 28 to 31 weeks, 32 to 36 weeks, and 37 to 41 weeks were 1.29, 1.36, and 1.22, respectively. Unlike the UA-PI and MCA-PI, the CPR was suitable as an independent predictor of neonatal acidosis at all late pregnancy weeks. In neonates with acidosis, the z score of the UA-PI increased significantly, whereas the z scores of the MCA-PI and CPR decreased significantly, in relation to normal values (P < .05).The CPR can be used to evaluate the adverse status of fetuses during late pregnancy, providing an early prediction of neonatal acidosis.


Assuntos
Acidose/diagnóstico , Doenças do Recém-Nascido/diagnóstico , Artéria Cerebral Média/diagnóstico por imagem , Fluxo Pulsátil , Artérias Umbilicais/diagnóstico por imagem , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Feto/metabolismo , Feto/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/metabolismo , Doenças do Recém-Nascido/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Diagnóstico Pré-Natal/métodos , Prognóstico , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodos
8.
Ceska Gynekol ; 84(3): 222-228, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324114

RESUMO

OBJECTIVE: An overview of current knowledge about the use of 3D ultrasound examinations for the examination of fetal CNS. DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics, Faculty of Medicine and Dentistry, Palacký University and Faculty Hospital Olomouc. METHODS: Literary sources related to the subject were used, especially articles indexed by Pubmed-Medline. CONCLUSION: 3D ultrasound is currently used for examination of fetal CNS structures that can be only very difficult displayed by conventional 2D ultrasound. The best for technique for visualisation of midline fetal CNS structures, respectively corpus callosum cerebellar vermis, appears to be 3D volume acquisition in a sagittal plane through the sagittal suture or large fontanel with further post-processing in multiplanar mode, OVIX (Samsung), TUI (GE Healthcare) etc.


Assuntos
Sistema Nervoso Central/diagnóstico por imagem , Feto/diagnóstico por imagem , Imagem Tridimensional/métodos , Ultrassonografia Pré-Natal/métodos , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez
9.
Cir. pediátr ; 32(3): 158-163, jul. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183737

RESUMO

Objetivo: Evaluar la importancia del diagnóstico ecográfico prenatal del feto portador de periorquitis meconial y su relevancia predictiva del seguimiento y pronóstico fetal en el contexto de una enfermedad intestinal fetal aguda. Material y métodos: En los últimos 5 años en la Unidad de Medicina Fetal se han diagnosticado tres fetos varones de periorquitis meconial cuyos diagnósticos ecográficos prenatales fueron: tumor testicular (n=1); y periorquitis meconial con perforación intestinal aguda fetal (n=2). La edad gestacional al diagnóstico fue de 33, 34 y 35 semanas. Los signos ecográficos al diagnóstico fueron: a nivel escrotal, aumento del tamaño, lesiones hiperecogénicas y permanencia del conducto peritoneo-vaginal; a nivel abdominal pueden existir signos ecográficos de enfermedad intestinal con o sin peritonitis meconial (lesiones hiperecogénicas, edemas de asas y ascitis). Los tres neonatos fueron evaluados postnatalmente mediante ecografía comparativa de los hallazgos prenatales e indicación terapéutica. Resultados: Los hallazgos ecográficos fetales influyeron en la evolución y finalización de la gestación. El diagnóstico de periorquitis meconial fue confirmado postnatalmente en los tres casos: en el 1er caso a término, se descartó patología tumoral escrotal y no requirió cirugía abdominal; en los otros dos pacientes se indicó finalizar la gestación tras el diagnóstico prenatal y se realizó cirugía inguino-escrotal y abordaje intestinal por la peritonitis meconial. Conclusión: El diagnóstico ecográfico prenatal de periorquitis meconial obliga a un seguimiento ecográfico estricto del feto al ser un marcador específico de perforación intestinal, que puede conllevar la finalización de la gestación y evitar la aparición de una peritonitis meconial complicada


Objective: To assess the importance of prenatal ultrasound diagnosis of the fetus carrying meconium periorchitis and its predictive relevance for fetal monitoring and prognosis in the context of acute fetal intestinal disease. Material and methods: Three male fetuses have been diagnosed of meconium periorchitis in our Unit of Fetal Medicine in the last 5 years. Their prenatal ultrasound diagnoses were: testicular tumor (n=1); Meconium periorchitis with acute fetal intestinal perforation (n=2). Gestational age at diagnosis was 33, 34 and 35 weeks. Ultrasound signs at diagnosis were: Increased size of scrotal zone, with hyperechogenic lesions inside and permanence of peritoneum-vaginal canal; at abdominal zone, echographic signs of intestinal disease with or without meconium peritonitis were found (hyperechogenic lesions, edema of intestinal loops and ascites). All three neonates were assessed postnatally by ultrasound and therapeutic indication. Results: Fetal ultrasound findings influenced both evolution and termination of pregnancy. The diagnosis of meconium periorchitis was confirmed postnatally in all cases: in the 1st case, delivered at term, scrotal tumoral pathology was ruled out and did not require abdominal surgery; the other 2 patients were delivered at the same week of prenatal diagnosis and an inguinal-scrotal surgery with intestinal approach because of meconium peritonitis was performed. No patient underwent orchiectomy, maintaining the teste-epididymal binomial intact. Conclusion: Prenatal ultrasound diagnosis of meconium periorchitis requires a strict ultrasound follow-up of the fetus as it is a specific marker of intestinal perforation, which can lead to the termination of pregnancy and avoid appearance of complicated meconium peritonitis


Assuntos
Humanos , Feminino , Gravidez , Adulto , Diagnóstico Pré-Natal , Orquite/diagnóstico por imagem , Mecônio/diagnóstico por imagem , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Orquite/terapia , Doenças Fetais/diagnóstico por imagem , Idade Gestacional , Neoplasias Testiculares/diagnóstico por imagem , Perfuração Intestinal/complicações , Peritonite/complicações , Peritonite/cirurgia
10.
Int J Gynaecol Obstet ; 147(1): 73-77, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31265126

RESUMO

OBJECTIVE: To evaluate the impact of a training program using a systematic protocol on ultrasound signs of placenta accreta spectrum (PAS). METHODS: Intra- and inter-observer variability rates and sensitivity were tested, before and after additional training, by two research fellows with a prior basic training in obstetric ultrasound using digitally recorded second-trimester ultrasound images from cases of anterior placenta previa with and without PAS. RESULTS: Fifty-two cases of anterior placenta previa with PAS (n=26) and without PAS (n=26) were included in the study. The highest level of inter-observer agreement for ultrasound signs was found for the absence of placental bulge and/or focal exophytic mass on gray-scale imaging and the absence of subplacental hypervascularity, bridging vessels and lacunar feeder vessels on color Doppler imaging. The level of inter-observer agreement increased from 39% before training to 40% after training; the numbers agreed as PAS by both trainees increased from four to 20. No cases were classified as inconclusive after training. There was a significant (P<0.001) change in sensitivity for both trainees after training. CONCLUSION: Additional training in detecting the ultrasound signs associated with PAS using a standardized protocol improves the diagnostic accuracy of operators with only a basic obstetric ultrasound training.


Assuntos
Obstetrícia/educação , Placenta Acreta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Programas de Rastreamento/métodos , Variações Dependentes do Observador , Gravidez , Segundo Trimestre da Gravidez , Avaliação de Programas e Projetos de Saúde
11.
Zhonghua Er Ke Za Zhi ; 57(6): 465-470, 2019 Jun 02.
Artigo em Chinês | MEDLINE | ID: mdl-31216805

RESUMO

Objective: To investigate the echocardiographic features of fetal Ebstein's anomaly (EA) and to analyze its clinical outcome and prognosis. Methods: A retrospective case-control study was conducted to analyze the echocardiographic features in fetus with EA. Thirty-five EA fetuses (EA group) and 35 normal fetuses matched for gestational age (control group) were enrolled. The main echocardiographic parameters of the two groups were collected and compared. According to the direction of blood flow in the ductus arteriosus (DA),fetuses in EA group were divided into DA reverse perfusion subgroup (n=11) and normal DA blood flow subgroup (n=24). The echocardiographic parameters and GOSE scores were compared between the two subgroups. The echocardiographic features of EA and the difference of fetal hemodynamics were summarized,and the clinical outcome of EA fetus was evaluated by GOSE score. Chi-square test Rank sum test or t test were used for comparison between groups. Results: Nineteen (54%) of the 35 patients terminated the pregnancy and 16 (46%) continued pregnancy until delivery during follow-up. Compared with the normal fetus group,the cardiothoracic ratio was significantly higher (0.47±0.11 vs. 0.34±0.01, t=6.640, P<0.01) and the transverse diameter ratio of right atrium to left atrium was significantly greater (1.42±0.38 vs. 1.08±0.11, t=5.030, P<0.01) in the EA group, and the ratio of pulmonary artery diameter to aortic diameter was significantly lower in the EA group (1.04±0.21 vs. 1.20±0.15, t=-3.770, P<0.01). Compared with the normal DA blood flow subgroup,the GOSE scores ≥ 1.5 was more frequently seen (7/11 vs. 3/24, P=0.004) and the ratio of pulmonary artery diameter to aortic diameter was significantly lower (0.91±0.18 vs. 1.24±0.20, t=-4.696, P=0.002) in the DA reverse perfusion subgroup. Six of the 16 delivery cases underwent EA corrective surgery after birth with 100% successful rate of operation. Among the 6 cases,two had preoperative GOSE score of ≥1.5 who were considered as severe cases,and four had low GOSE score of<1.5. The remaining ten cases who had not undergone the corrective surgery were followed up routinely. Conclusion: Prenatal hemodynamics of EA combined with GOSE score can more accurately evaluate the severity and prognosis of fetal EA, reduce unnecessary labor induction, and improve postpartum cure rate and clinical outcomes.


Assuntos
Anomalia de Ebstein/diagnóstico por imagem , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal/métodos , Ultrassonografia/métodos , Estudos de Casos e Controles , Feminino , Humanos , Cuidado Pós-Natal , Gravidez , Cuidado Pré-Natal , Prognóstico , Estudos Retrospectivos
12.
Zhonghua Fu Chan Ke Za Zhi ; 54(5): 318-323, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31154713

RESUMO

Objective: To investigate the predictive value of cervical length (CL) measured by transvaginal ultrasound for preterm birth <32 weeks, <34 weeks in twin pregnancies in the second and the third trimester of pregnancy. Methods: A total of 490 twin pregnant women with CL measured by transvaginal ultrasound during the second trimester of pregnancy (20-24 weeks) and the third trimester of pregnancy (28-32 weeks) delivered in Peking University Third Hospital, and Tongzhou Maternal and Child Health Hospital from January 2014 to December 2017 were collected, and 161 cases out of which were measured by CL during both the second trimester and the third trimester of pregnancy. Based on the measured gestational weeks, 427 cases were in the second trimester group and 224 cases in the third trimester group. The predictive value of CL for preterm birth was evaluated by calculating the optimal cut-off point with sensitivity and specificity. Logistic regression analysis was used to assess the relationship between CL and preterm birth after adjusting for confounding factors (age of pregnant women, chorionic status, mulipara, assisted reproductive pregnancy and pre-pregnancy body mass index). Results: (1) The median CL of pregnant women in the second trimester group and the third trimester group were 36 mm (33-40 mm) and 28 mm (18-33 mm) respectively. In the second trimester group, 151 cases (35.4%, 151/427) were preterm birth and 276 cases (64.6%, 276/427) were full-term birth; the median CL of preterm and full-term pregnant women were 34 mm (30-37 mm) and 37 mm (34-40 mm), respectively, with significant difference (P<0.01). In the third trimester group, 100 cases (44.6%, 100/224) were preterm birth and 124 cases (55.4%, 124/224) were full-term birth; the median CL of preterm and full-term pregnant women were 22 mm (15-30 mm) and 31 mm (23-34 mm), respectively, with significant difference (P<0.01). (2) Prediction of preterm birth <32 weeks and <34 weeks was performed with CL in the second trimester group. The area under the receiver-operating characteristics curve were 0.78 (95%CI: 0.70-0.86) and 0.71 (95%CI: 0.64-0.79), respectively. The optimal cut-off points were 36.5 mm and 33.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth <32 weeks and <34 weeks of gestation. (3) Prediction of preterm birth <32 weeks and <34 weeks were performed with CL in the third trimester group. The area under the receiver-operating characteristics curve were 0.86 (0.75-0.96) and 0.75 (0.67-0.84), respectively. The optimal cut-off points were 17.5 mm and 18.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth at <32 weeks and <34 weeks of gestation. Conclusions: CL measured by transvaginal ultrasound in the second and the third trimester is a good predictor for preterm birth of twin pregnancy. CL≤36.5 mm and ≤33.5 mm at 20-24 weeks of gestation could predict preterm birth <32 weeks and <34 weeks respectively. CL≤17.5 mm and ≤18.5 mm at 28-32 weeks of gestation could predict preterm birth <32 weeks and <34 weeks respectively.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Gravidez de Gêmeos , Nascimento Prematuro , Ultrassonografia Pré-Natal/métodos , Criança , Feminino , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Sensibilidade e Especificidade , Ultrassonografia
13.
Med Sci Monit ; 25: 3170-3180, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31036798

RESUMO

The umbilical cord is the only connection between the mother and the fetus, through which it is possible to transport respiratory gases, nutrients, and metabolites. Thanks to the umbilical cord, the fetus has also the ability to move, which is necessary for its proper psychomotor development. The correct structure and function of umbilical vessels and the entire umbilical cord determine the possibility of proper development and survival of the fetus. Umbilical cord anatomy should be assessed in the ultrasound examination in the first trimester. It is of vital importance to confirm the correct number of umbilical vessels and their intra-abdominal course, as well as carefully assessing the abdominal and placental insertion sites. In the latter half of pregnancy, the use of the Doppler imaging enables assessment of the function of the fetal-placental vessels, thus providing valuable information about the condition of the fetus.


Assuntos
Diagnóstico Pré-Natal/métodos , Ultrassonografia Pré-Natal/métodos , Cordão Umbilical/anormalidades , Cordão Umbilical/diagnóstico por imagem , Feminino , Sofrimento Fetal/diagnóstico por imagem , Feto/diagnóstico por imagem , Feto/metabolismo , Humanos , Gravidez
14.
J Clin Ultrasound ; 47(7): 399-404, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31124158

RESUMO

PURPOSE: We aimed to investigate whether transabdominal uterine artery (UtA) pulsatility index (PI) differs between monochorionic (MC) diamniotic and dichorionic (DC) twins and is useful to predict pregnancy complications. METHODS: A total of 406 uncomplicated twin pregnancies (94 MC, 312 DC) were examined at 22+0 -24+6 weeks and compared for demographic characteristics, mean UtA PI, presence of notch, development of preeclampsia, fetal growth restriction (FGR), placental abruption, intrauterine fetal death and preterm delivery. Mann-Whitney and Fisher's exact tests were performed for continuous and categorical variables, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio were calculated for mean PI >95th percentile, presence of notch, and presence of either elevated PI or notch. RESULTS: Median mean UtA PI was 0.68 in DC and 0.75 in MC pregnancies (P = .005). Bilateral notches were observed in one MC pregnancy; unilateral notch was seen in 8 DC (2.6%) and 5 MC diamniotic (5.3%) pregnancies. FGR occurred more frequently in DC twin pregnancies, while intrauterine fetal death in MC. Overall, the sensitivity of the parameters tested was low. Pregnancies with both PI above 95th percentile and presence of notch were all associated with complications, particularly FGR. CONCLUSION: MC pregnancies have higher mean UtA PI. UtA screening in twins shows lower performances than in singletons for the detection of complications.


Assuntos
Complicações na Gravidez/diagnóstico por imagem , Gravidez de Gêmeos , Artéria Uterina/diagnóstico por imagem , Adulto , Feminino , Morte Fetal , Retardo do Crescimento Fetal/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro , Estudos Retrospectivos , Natimorto , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos
15.
Indian J Ophthalmol ; 67(6): 958-960, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124531

RESUMO

We report a case of non-familial, sporadic fetal retinoblastoma (RB) that was accidently detected at 39 weeks of gestation on pre-natal ultrasonography in left eye (OS). Post-natal examination revealed Group A and, Group D RB in right eye (OD) and OS, respectively. At 35 days, selective ophthalmic artery intra-arterial chemotherapy (IAC) was performed in OS and laser for OD. Pre-natal ultrasound and its application in RB are limited to those cases with a strong genetic predisposition. Our case was accidently detected at late gestation with no familial or genetic predisposition. In addition, this was the youngest reported case that received IAC on literature review.


Assuntos
Antineoplásicos/administração & dosagem , Retina/diagnóstico por imagem , Retinopatia da Prematuridade/diagnóstico , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Recém-Nascido , Injeções Intra-Arteriais , Masculino , Artéria Oftálmica , Gravidez , Retinopatia da Prematuridade/tratamento farmacológico , Retinopatia da Prematuridade/embriologia
16.
S Afr Med J ; 109(5): 347-352, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31131803

RESUMO

BACKGROUND: In South Africa (SA), the largest category of perinatal deaths is unexplained stillbirths. Two-thirds of these occur in the antenatal period and most fetuses are macerated, but at antenatal clinics the mothers were generally regarded as healthy, with low-risk pregnancies. Innovative methods are urgently required to detect fetuses at risk of stillbirth and manage the mothers appropriately. OBJECTIVES: To determine the prevalence of raised resistance indices (RIs) of the umbilical artery in a low-risk, low-income population and ascertain whether use of this information can prevent perinatal deaths. METHODS: A descriptive study was performed in Mamelodi township, east of Pretoria, SA, on pregnant women attending antenatal clinics draining to two community health centres (CHCs). These women, classified as having low-risk pregnancies, were screened for placental insufficiency using a continuous-wave Doppler ultrasound apparatus (Umbiflow) between 28 and 32 weeks' gestation. When a raised RI was detected, the mother was referred to a high-risk clinic and managed according to a standard protocol. A cohort analytical study compared women who attended antenatal care at the same clinics as the Umbiflow group but did not have an Umbiflow test with those who had an Umbiflow test. The outcomes of all the deliveries in Mamelodi were recorded. The prevalences of abnormal RIs, absent end-diastolic flow (AEDF), stillbirths and neonatal deaths were the main outcome measures. RESULTS: An Umbiflow RI was performed in 2 868 women, and pregnancy outcome was available for 2 539 fetuses (88.5%); 297 fetuses (11.7%) were regarded as at high risk. AEDF was found in 1.5% of the population screened with an outcome. There were 29 perinatal deaths in the Umbiflow group (low risk n=18, high risk n=11). The perinatal mortality rate for 12 168 women attending the CHCs and the antenatal clinics draining to the CHCs who did not have an RI was 21.3/1 000 births, significantly higher than that in the Umbiflow group (11.4/1 000 births) (risk ratio 0.58, 95% confidence interval 0.42 - 0.81). CONCLUSIONS: The prevalence of AEDF in this low-risk population is ~10 times higher than that previously recorded. Use of the information prevented a number of perinatal deaths, most of which would have been macerated stillbirths. Screening a low-risk pregnant population using continuous-wave Doppler ultrasound may substantially reduce the prevalence of unexplained stillbirths in SA.


Assuntos
Programas de Rastreamento/métodos , Cuidado Pré-Natal/métodos , Gestão de Riscos/métodos , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem , Resistência Vascular/fisiologia , Adulto , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Mortalidade Perinatal/tendências , Pobreza , Gravidez , Resultado da Gravidez , Fluxo Sanguíneo Regional/fisiologia , Fatores de Risco , África do Sul/epidemiologia , Taxa de Sobrevida/tendências , Artérias Umbilicais/fisiopatologia , Adulto Jovem
17.
Radiol Clin North Am ; 57(3): 617-633, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30928081

RESUMO

Ultrasound is the imaging study of choice for detection and full characterization of early pregnancies based on its accuracy, low cost, safety profile, and abundant availability. This article reviews the goals and utility of first-trimester ultrasound in gestation localization, viability determination, and abnormal pregnancies, including ectopic implantation, retained products, and molar pregnancy.


Assuntos
Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Gravidez Ectópica/diagnóstico por imagem , Sensibilidade e Especificidade , Terminologia como Assunto
18.
Ann Vasc Surg ; 59: 313.e1-313.e3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009730

RESUMO

BACKGROUND: Pregnancy is a hypercoagulable state associated with a fivefold increase in the risk of venous thromboembolism. Thrombolysis is the preferred level of care for patients with acute iliofemoral deep vein thrombosis (DVT); however, most studies exclude pregnant patients, highlighting the lack of data regarding the efficacy and safety of thrombolytic therapy for mother and fetus. METHODS: We describe the successful use of thrombolytic therapy in conjunction with ultrasound to remove a large ileofemoral DVT in a first-trimester patient with phlegmasia cerulea dolens. The procedure was performed safely for both mother and fetus. RESULTS: No radiation or contrast dye was used, and intravascular ultrasound confirmed patency of the entirety of the venous system. She delivered a healthy term baby after the procedure and had no further sequalae. CONCLUSION: Thrombolysis with intravascular ultrasound may be considered in first-trimester pregnant patients with threatened limb due to DVT.


Assuntos
Veia Femoral/efeitos dos fármacos , Fibrinolíticos/administração & dosagem , Veia Ilíaca/efeitos dos fármacos , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Terapia Trombolítica , Tromboflebite/tratamento farmacológico , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Nascimento Vivo , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Tromboflebite/diagnóstico por imagem , Tromboflebite/fisiopatologia , Resultado do Tratamento , Ultrassonografia de Intervenção , Ultrassonografia Pré-Natal/métodos , Grau de Desobstrução Vascular
19.
Medicine (Baltimore) ; 98(16): e15193, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008942

RESUMO

This study sought to investigate the effects of placental laterality on the measurements of uterine artery (UtA) Doppler velocimetry and their application in predicting early-onset preeclampsia (PE).We conducted a prospective cohort study on all women with singleton, uncomplicated pregnancies scheduled for first-trimester nuchal translucency at our institution. Pulsatility index (PI) for both UtAs was measured by Doppler velocimetry, and placental laterality was determined. Additionally, pregnancy outcome data were abstracted from the medical records. Receiver operating characteristic curves (ROCs) were plotted.Of the 304 patients enrolled, 247 met the inclusion criteria. Among these patients, 240 had uncomplicated delivery, while 7 had early delivery at <34 weeks due to PE. For the uncomplicated pregnancies, PI measurements of the UtA ipsilateral to the placenta were similar (left versus right UtA: 1.06 ±â€Š0.38 vs. 1.04 ±â€Š0.40; P = .745). However, PI measurements of the UtA contralateral to the placenta differed significantly (left versus right UtA: 1.45 ±â€Š0.51 vs. 1.3 ±â€Š0.47; P = .027). In predicting early-onset PE, the ideal cut-off value for the placental side PI was 1.91, with sensitivity 100% and specificity 96.3%. For nonplacental side PI, the ideal cut-off value for PI was 1.975, with sensitivity 57.1% and specificity 79.2%. Using the mean of the left and right UtA PI, the ideal cut-off value was 1.63, with sensitivity 100% and specificity 74.2%.ROC analysis confirmed that PI measurements of the UtA on the placental side were significantly lower than those on the contralateral side, PI measurements of the UtA ipsilateral to the placenta were similar.


Assuntos
Pré-Eclâmpsia/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Artéria Uterina/diagnóstico por imagem , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Adulto Jovem
20.
J Clin Ultrasound ; 47(7): 394-398, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30838673

RESUMO

PURPOSE: This study was undertaken to evaluate the performance of indirect sonographic signs in detecting partial agenesis of the corpus callosum (pACC) at midgestation, focusing on the cavum septum pellucidum (CSP) ratio. METHODS: A retrospective case-controlled study of singleton pregnancies was conducted, examining fetuses diagnosed with isolated pACC and normal controls. At midgestational age, fetal head volumes were imaged with 3D US and stored for the evaluation of indirect sonographic findings in axial planes. RESULTS: Fifteen normal and 15 abnormal fetuses (with pACC) were analyzed. Based on a CSP ratio < 1.5, detection of pACC increased from 66.7% (10/15) to 80% (12/15). All indirect signs proved highly suspicious for pACC (risk ratios > 1). CONCLUSION: Use of indirect sonographic signs to screen for pACC at midgestation is challenging. However, a low CSP ratio may improve the detection rate, serving as a new indirect sign.


Assuntos
Agenesia do Corpo Caloso/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Septo Pelúcido/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Corpo Caloso/diagnóstico por imagem , Feminino , Humanos , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Ultrassonografia/métodos , Ultrassonografia Pré-Natal/métodos , Adulto Jovem
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